THE extreme stress of the return of foot-and-mouth to County Durham could lead to alcoholism and even domestic violence.

But health professionals say there has been a low uptake of the front-line services set up to offer help.

However, one answer could be a mobile surgery offering health screening at markets, fairs and farms.

A report to yesterday's meeting of County Durham and Darlington health authority said there had been 93 cases of the disease since February. But one single case resulted in a cull at 33 farms in upper Teesdale.

Repercussions had been felt in related businesses such as stone walling, feed merchants, shearers and hauliers as well as tourism.

On September 4, the county would have reached a three-month milestone when movement restrictions were due to relax.

But further outbreaks in Northumberland and Consett plunged it back into a zone restricting farms to a "straight to slaughter" only policy.

Prolonged anxiety and stress could result in long-term health risks, including intestinal problems, depression, an increased risk of domestic violence and excessive alcohol use.

"The second wave of FMD is particularly worrying as the level of resilience within the communities is low and so the ability to cope with ongoing anxiety is reduced," says the report.

Local action had centred around the economic regeneration of communities, with little call on health services.

"It is clear the primary need for support is to address financial difficulties, secondly FMD specific guidance regarding licences and animal movement and thirdly problems associated with isolation, family pressures and anxiety."

One proposal is to copy an occupational health service being implemented in Cumbria and Lancashire.

Two nurses take an equipped surgery to rural meeting points and apart from health screening and promotion, also take minor consultations.

"The service is well-used by the rural community and they are increasingly asked to attend individual farms to deliver health services."

The report adds: "Finally, vets are going to have reduced case loads when the epidemic has abated. They are familiar with farmers and trusted by them and they may well have a role in engaging clients who appeared to be experiencing ongoing problems, referring them to the appropriate service.

"This would also be a pro-active measure to help this professional group adjust to the new order."